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Nepal Demographic and Health Survey 2022 Key Indicators Report

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Überblick

Das Nepal Demografische und Gesundheitsumfrage 2022 (NDHS) wurde von New ERA unter der Ägide des Ministeriums für Gesundheit und Bevölkerung (MOHP) implementiert. Die Datenerhebung fand vom 5. Januar bis 22. Juni 2022 statt. ICF leistete technische Unterstützung durch das DHS-Programm, das von der United States Agency for International Development (USAID) finanziert wird und finanzielle Unterstützung und technische Unterstützung für Bevölkerungs- und Gesundheitserhebungen in Ländern bietet weltweit. Suaahara II, die integrierte Ernährungsaktivität von USAID, unterstützte den ethischen Überprüfungsprozess der Umfrage in Nepal.

Dieser Key Indicators Report gibt einen ersten Einblick in ausgewählte Ergebnisse der NDHS 2022. Eine umfassende Analyse der Daten wird 2023 in einem Abschlussbericht vorgelegt.

Umfrageziele

Das Hauptziel des NDHS 2022 besteht darin, aktuelle Schätzungen grundlegender demografischer und gesundheitlicher Indikatoren vorzulegen. Das NDHS bietet einen umfassenden Überblick über die Gesundheit von Bevölkerung, Müttern und Kindern in Nepal. Insbesondere sammelte das NDHS 2022 Informationen zu Fruchtbarkeitsniveaus, Ehe, Fruchtbarkeitspräferenzen, Bewusstsein und Anwendung von Familienplanungsmethoden, Stillpraktiken, Ernährung, Gesundheit von Mutter und Kind, Kindersterblichkeit, Bewusstsein und Verhalten in Bezug auf HIV und andere sexuell übertragbare Infektionen (STIs). , Stärkung der Rolle der Frau und häusliche Gewalt, Fisteln, psychische Gesundheit, Unfälle und Verletzungen, Behinderung, Ernährungsunsicherheit und andere gesundheitsbezogene Themen wie Rauchen, Kenntnisse über Tuberkulose und Prävalenz von Bluthochdruck.

Die im Rahmen des NDHS 2022 gesammelten Informationen sollen politischen Entscheidungsträgern und Programmmanagern bei der Gestaltung und Bewertung von Programmen und Strategien zur Verbesserung der Gesundheit der nepalesischen Bevölkerung helfen. Die NDHS 2022 liefert auch Indikatoren, die für die Nepal Health Sector Strategy 2016-22, den nächsten in Entwicklung befindlichen Strategieplan für den Gesundheitssektor und die Ziele für nachhaltige Entwicklung (SDGs) für Nepal relevant sind.

Musterdesign

Der für das NDHS 2022 verwendete Stichprobenrahmen ist eine aktualisierte Version des Rahmens der nepalesischen Bevölkerungs- und Wohnungszählung (NPHC), die 2011 durchgeführt wurde und vom Central Bureau of Statistics bereitgestellt wird. Die kleinste Verwaltungseinheit in Nepal ist der Unterbezirk. Der Volkszählungsrahmen enthält eine vollständige Liste der 36.020 Unterbezirke Nepals. Jede Untergemeinde hat einen Wohntyp (städtisch oder ländlich), und ein Maß für die Größe ist die Anzahl der Haushalte.

Fakten & Tendenzen

Fruchtbarkeit

Es gab einen stetigen Rückgang der Gesamtfruchtbarkeitsrate von 4,8 Geburten pro Frau im NFHS von 1996 auf 2,1 Geburten pro Frau im NDHS 2022.

Die Fruchtbarkeit ist bei Jugendlichen gering (71 Geburten pro 1.000 Frauen im Alter von 15–19 Jahren), Spitzen bei 160 Geburten pro 1.000 bei Frauen im Alter von 20 bis 24 Jahrenund stirbt danach.

Gesamt, 14 % der Frauen im Alter von 15 bis 19 Jahren jemals schwanger waren, einschließlich 10 %, die eine Lebendgeburt hatten, 2 %, die einen Schwangerschaftsabbruch erlitten haben, und 4 %, die derzeit schwanger sind.

Teenagerschwangerschaften sind am höchsten Provinz Karnali (21%)gefolgt von der Provinz Madhesh (20 %) und am niedrigsten in der Provinz Bagmati (8 %).

Zehn Prozent (10%) der Frauen möchten bald ein weiteres Kind (innerhalb der nächsten 2 Jahre), 13 % möchten später ein weiteres Kind haben (in 2 oder mehr Jahren) und 1 % möchten ein weiteres Kind, haben sich aber noch nicht entschieden, wann.

Dreiundfünfzig Prozent (53 %) der Frauen wollen keine Kinder mehr, 17 % sind sterilisiert und 3 % gaben an, unfruchtbar zu sein.

Familienplanung

Die Nutzung jeglicher Familienplanungsmethode unter derzeit verheirateten Frauen stieg von 29 % im Jahr 1996 auf 57 % im Jahr 2022. Im gleichen Zeitraum stieg die Nutzung moderner Verhütungsmethoden von 26 % im Jahr 1996 auf 44 % im Jahr 2006. Sie hat sich von 2011 bis 2022 konstant bei 43 % gehalten.

Siebenundfünfzig (57%) der derzeit verheirateten Frauen wenden eine Verhütungsmethode an; 43 % verwenden eine moderne Methodeund 15 % verwenden eine traditionelle Methode.

Die beliebtesten modernen Methoden sind weibliche Sterilisation (13%)Injektionen (9 %) und Implantate (6 %).

Die Auszahlung ist bei weitem die am häufigsten verwendete traditionelle Methode; 13 % der derzeit verheirateten Frauen verwenden diese Methode im Vergleich zu 2 %, die die Rhythmusmethode verwenden.

Einundzwanzig Prozent (21%) der derzeit verheirateten Frauen in Nepal haben einen ungedeckten Bedarf an Familienplanungsdiensten.

Frühkindliche Sterblichkeit

Zwischen den NFHS-Erhebungen von 1996 und den NDHS-Erhebungen von 2022 ging die Sterblichkeit der Kinder unter 5 Jahren von 118 auf 33 Todesfälle pro 1.000 Lebendgeburten, die Säuglingssterblichkeit von 78 auf 28 Todesfälle pro 1.000 Lebendgeburten und die Neugeborenensterblichkeit von 50 auf 21 Todesfälle pro 1.000 Lebendgeburten zurück Geburten. Bemerkenswert ist jedoch, dass sich die Neugeborenensterblichkeit zwischen dem NDHS 2016 und 2022 nicht verändert hat.

  • In den 5 Jahren unmittelbar vor der Erhebung, insgesamt Die Sterblichkeitsrate unter 5 Jahren betrug 33 Todesfälle pro 1.000 Lebendgeburten.
  • Das Die Säuglingssterblichkeitsrate lag bei 28 Todesfällen pro 1.000 Lebendgeburten.
  • Das Kindersterblichkeit Rate war 5 Todesfälle pro 1.000 Kinder, die bis zum Alter von 12 Monaten überleben.
  • Das Neugeborenensterblichkeit Rate war 21 Todesfälle pro 1.000 Lebendgeburtenin den 5 Jahren unmittelbar vor der Erhebung.
  • Fünfundachtzig Prozent (85 %) aller Todesfälle bei Kindern unter 5 Jahren in Nepal ereignen sich vor dem ersten Geburtstag eines Kindeswobei 64 % im ersten Lebensmonat auftreten.

Mütterliche Fürsorge

Der Prozentsatz der Frauen, die bei ihrer letzten Lebendgeburt in den 2 Jahren vor der Umfrage Schwangerschaftsvorsorge von einem qualifizierten Anbieter erhielten, stieg von 25 % im Jahr 1996 auf 94 % im Jahr 2022. Ebenso stieg der Anteil der Frauen, die vier oder mehr ANC-Besuche machten, von 9 %. im Jahr 1996 auf 81 % im Jahr 2022. Der Prozentsatz der Lebendgeburten, die von einem qualifizierten Anbieter betreut werden, ist deutlich gestiegen, von 10 % im Jahr 1996 auf 80 % im Jahr 2022).

  • Vierundneunzig Prozent (94%) der Frauen gaben an, dass sie in den 2 Jahren vor der Umfrage Schwangerschaftsvorsorge von einem qualifizierten Anbieter für ihre letzte Lebend- oder Totgeburt erhalten haben.
  • Vier von fünf Frauen (81 %) hatten mindestens vier ANC-Besuche für ihre letzte Lebendgeburt.
  • Gesamt, 96 % der Frauen nahmen eisenhaltige Nahrungsergänzungsmittel ein während ihrer letzten Schwangerschaft.
  • Gesamt, 93 % der Frauen mit einer Lebendgeburt in den 2 Jahren vor der Umfrage erhielten ausreichende Dosen von Tetanustoxoid-Injektionen, um ihr Baby vor neonatalem Tetanus zu schützen.
  • Gesamt, 79 % der Lebendgeburten und Totgeburten in den 2 Jahren vor der Erhebung wurden in Gesundheitseinrichtungen abgegeben.
  • Vier von fünf (80 %) Lebendgeburten und Totgeburten wurden von erfahrenen Anbietern geliefert.
  • Gesamt, 70% der Frauen mit einer Lebend- oder Totgeburt in den 2 Jahren vor der Befragung erhielt a postnatale Kontrolle innerhalb von 2 Tagen nach Lieferung.

Impfschutz

Der Prozentsatz der Kinder im Alter von 12 bis 23 Monaten, die vollständig geimpft sind (alle Basisantigene erhalten haben), schwankte im Laufe der Zeit und stieg von 43 % im Jahr 1996 auf einen Höchststand von 87 % im Jahr 2011, ging dann auf 78 % im Jahr 2016 zurück und stieg wieder an leicht auf 80 % im Jahr 2022. Der Anteil der Kinder im Alter von 12 bis 23 Monaten, die keine Impfungen erhalten haben, schwankte ebenfalls und stieg insbesondere leicht von 1 % im Jahr 2016 auf 4 % im Jahr 2022.

  • Gesamt, 80 % der Kinder im Alter von 12–23 Monaten sind vollständig mit basischen Antigenen geimpft.
  • Fünfundneunzig Prozent (95 %) der Kinder im Alter von 12–23 Monaten erhielten BCG-Impfstoff, 89 % erhielten die dritte Dosis DTP-HepB-Hib, 86 % erhielten die dritte Dosis OPV und 89 % erhielten eine Dosis MR.
  • Etwas mehr als die Hälfte der Kinder im Alter von 12 bis 23 Monaten (52 %) sind gemäß dem nationalen Impfplan vollständig geimpft.
  • Fünfundachtzig Prozent (85 %) der Kinder erhielten die zweite fIPV-Dosis, 81 % die dritte PCV-Dosis, 72 % die 2. RV-Dosis und 81 % eine JE-Impfstoffdosis.
  • Vier Prozent (4%) der Kinder im Alter von 12–23 Monaten haben keine Impfungen erhalten.

Ernährungsstatus des Kindes

Die Prävalenz von Wachstumsverzögerung ist von 57 % im Jahr 1996 auf 25 % im Jahr 2022 zurückgegangen. Im selben Zeitraum ging die Prävalenz von Auszehrung von 15 % auf 8 % zurück, und die Prävalenz von Übergewicht blieb konstant bei 1 %.

  • Nach den drei anthropometrischen Indizes: 25 % der Kinder unter 5 Jahren sind unterentwickelt, 8 % sind ausgezehrt und 19 % sind untergewichtig. Ein Prozent der Kinder unter 5 Jahren sind übergewichtig.

Ernährung von Säuglingen und Kleinkindern

Das ausschließliche Stillen bei Kindern im Alter von 0 bis 5 Monaten hat stark geschwankt – es ging von 75 % im Jahr 1996 auf 53 % im Jahr 2006 zurück, stieg dann auf 70 % im Jahr 2011 und ging auf 56 % im Jahr 2022 zurück.

  • Fünfundfünfzig Prozent (55 %) der Kinder im Alter von 0–23 Monaten beginnen früh mit dem Stillen.
  • Achtundsiebzig Prozent (78%) der Kinder im Alter von 6 bis 23 Monaten erfüllten die Mindestanforderungen an die Ernährungsvielfalt.
  • Sechsundfünfzig Prozent (56%) der Kinder unter 6 Monaten wurden ausschließlich gestillt.
  • Dreiundvierzig Prozent (43 %) der Kinder im Alter von 6–23 Monaten erhielten ein süßes Getränk.
  • Neunundsechzig Prozent (69%) der Kinder im Alter von 6–23 Monaten konsumieren ungesunde Lebensmittel.

Anämie

Die Prävalenz der Anämie bei Kindern im Alter von 6–59 Monaten ist von 48 % im Jahr 2006 auf 43 % im Jahr 2022 zurückgegangen. Der Trend war jedoch nicht durchgehend rückläufig – im Jahr 2016 waren 53 % der Kinder anämisch. Die Prävalenz der Anämie bei Frauen im Alter von 15–49 Jahren stieg von 36 % im Jahr 2006 auf 41 % im Jahr 2016 und ging auf 34 % im Jahr 2022 zurück.

  • Dreiundvierzig (43) % der Kinder im Alter von 6–59 Monaten sind anämisch, darunter 25 % mit leichter Anämie, 18 % mit mäßiger Anämie und weniger als 1 % mit schwerer Anämie.
  • Vierunddreißig (34) % der Frauen sind anämisch, einschließlich 18 %, die leicht anämisch sind, 15 %, die
  • sind mäßig anämisch und 1 % sind stark anämisch.
  • Frauen, die in der Terai-Ökozone leben, sind eher anämisch (45 %) als diejenigen, die in Hügel- (20 %) und Bergregionen (23 %) leben. Mehr als die Hälfte der Frauen (52 %) in der Provinz Madhesh, die in der ökologischen Zone Terai liegt, sind anämisch.

HIV

  • Fünfundsechzig Prozent (65%) der jungen Frauen und 88 % der jungen Männer wissen, dass die konsequente Verwendung von Kondomen das HIV-Risiko verringern kann.
  • Neunundsechzig Prozent (69%) der jungen Frauen und 85 % der jungen Männer wissen, dass schon ein nicht infizierter Partner die Wahrscheinlichkeit einer HIV-Infektion verringern kann.
  • Nur 16 % der jungen Frauen und 27 % der jungen Männer verfügen über fundierte Kenntnisse der HIV-Präventionsmethoden.
  • Insgesamt wurden 10 % der Frauen und 13 % der Männer im Alter von 15–49 Jahren jemals auf HIV getestet.
  • Drei Prozent (3 %) der Frauen und 2 % der Männer im Alter von 15 bis 49 Jahren wurden in den 12 Monaten vor der Umfrage auf HIV getestet und erhielten die Ergebnisse des letzten durchgeführten Tests.

Behinderung

  • Gesamt, 71 % der De-facto-Haushaltsbevölkerung ab 5 Jahren haben in keinem der Funktionsbereiche Schwierigkeiten.
  • Von der de facto Haushaltsbevölkerung ab 5 Jahren haben 23 % einige Schwierigkeiten in mindestens einem Funktionsbereich, 5 % haben große Schwierigkeiten und 1 % kann mindestens einen Bereich nicht beherrschen.
  • Sechs Prozent (6 %) der De-facto-Haushaltsmitglieder ab 5 Jahren haben große Schwierigkeiten oder können in mindestens einem der Funktionsbereiche überhaupt nicht funktionieren.
  • Unter der De-facto-Haushaltsbevölkerung ab 5 Jahren ist die am häufigsten genannte Behinderung Sehstörung (15 %), gefolgt von Schwierigkeiten beim Gehen oder Treppensteigen (12 %).

Ministerium für Gesundheit und Bevölkerung, Nepal; Neue Ära; und ICF. 2022. Nepal Demographic and Health Survey 2022: Key Indicators Report. Kathmandu, Nepal: Ministerium für Gesundheit und Bevölkerung, Nepal.

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Readers and Tweeters Decry Medical Billing Errors, Price-Gouging, and Barriers to Benefits

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Letters to the Editor is a periodic feature. We welcome all comments and will publish a selection. We edit for length and clarity and require full names.

Envy for-profit US healthcare? Check out this MD whose wife is a medical billing expert who spent over a year challenging an egregious billing error. After it all they still paid $1200. These are resourceful knowledgeable people who got taken for a ride. https://t.co/fnlUz3KTJb

— Raghu Venugopal MD (@raghu_venugopal) October 26, 2022

— Dr. Raghu Venugopal, Toronto

A Plea for Sane Prices

I just read your story about the emergency room billing for a procedure that was not done (“A Billing Expert Saved Big After Finding an Incorrect Charge in Her Husband’s ER Bill,” Oct. 25). We too had a similar experience with an emergency room and a broken arm that was coded at a Level 5, and it was a simple break. No surgery needed, and it took them only 10 minutes to set and wrap the broken arm but charged us over $9,000. I disputed the charges, and it took six months to get them to reduce the bill but they never admitted that they coded a simple break incorrectly to jack up the price of the bill. If it had been a Level 5 issue, we would not have sat in the waiting room for six hours before being seen. It was a horrible experience, and I think ERs all over the nation are doing this to make up for the non-payers they treat every day. It is robbery.

— Terrence Campbell, Pocatello, Idaho

It would be great if the vaulted @Centre County Reportews would clearly distinguish between the ED pro fee billing & hospital charges as it is not entirely clear here w/ in network svs.—Billing Expert Saved Big After Finding an Incorrect Charge in Her Husband’s ER Bill https://t.co/jRFAYb5F0P

— Ed Gaines (@EdGainesIII) October 25, 2022

— Ed Gaines, Greensboro, North Carolina

As you said, CPT codes should always be examined. This case is probably more than “just an error.” As a retired orthopedic surgeon, chief of surgery, and chief of staff at a North Carolina hospital, I have seen care such as this coded exactly like this with the rationale that, “Hey, this was a fractured humerus and it was manipulated and splinted.” 24505 is correct IF that is the definitive treatment, which it was not here. Even code 24500 would indicate definitive treatment without manipulation. This was just temporary care until definitive care could be done later. It should be billed as a visit and a splint. The visit for this, if it was an isolated problem (no other injury or problems), would qualify only as a Level 2 visit. That frequently gets upcoded as well by adding a lot of non-pertinent family, medical, and social history and a complete physical exam (seven systems at least) and a whole lot of non-pertinent “medical decision making.” All of that should be documented in the medical records even if the hospital stonewalls on the CPT codes.

Look closely at medical records and you will find frequent upcoding, if you are familiar with the requirements for different levels of treatment.

— Dr. Charles Beemer, Arvada, Colorado

Never attribute to Baumol’s cost disease that which is adequately explained by malice. https://t.co/RbKOlBgCmp

— Shashank Bhat (@shashank_ps) October 26, 2022

— Shashank Bhat, San Francisco

A number of years ago, I was billed using a code that described a treatment that was not carried out. In similar fashion, I talked with my insurance company, which basically said it did not care whether the treatment took place or not as all it required was for a valid code to appear. I also contacted the Virginia Bureau of Insurance, which approves the various policies, and it said it had no jurisdiction over claims. I decided to let the hospital sue me for the disputed amount and defended myself in district court. Despite their attorney and four “witnesses,” the case was thrown out because the hospital was both unwilling and unable to justify the charges to the satisfaction of the judge. They did not want anybody in power to testify because of the questions they would have been asked, so they left it to people who were completely clueless. The takeaways from this were:

  • Hospitals make up the numbers and leave them grossly inflated so they can claim that they are giving away care when they give discounts on the made-up numbers.
  • Hospitals turn employees into separate billing entities so they can double-charge.
  • Hospitals open facilities such as physical therapy in hospital locations because insurance companies will pay higher amounts when treatment is carried out in a hospital environment.
  • Insurance companies and state insurance agencies do not act as gatekeepers to protect their clients/taxpayers.
  • The insurance companies and the providers have a shared interest in the highest possible ticket prices and outrageous charges because the providers get to claim how generous they are with “unremunerated care,” and if the prices were affordable then they could not justify the high prices for insurance premiums and the allowed administration/profit share of 20% would be based on a far smaller amount.

In any other industry, this would have resulted in multiple antitrust suits. U.S. health care is a sad example of government, health care industry, and insurers all coming together against the interests of consumers. After this court case, I wanted to form a nonprofit to systematically challenge every outrageous charge against people who, unlike myself, did not believe or know how to defend themselves. If hospitals and other providers were forced to go to court to justify their charges on a systematic basis, pricing sanity would eventually prevail.

— Philip Solomon, Richmond, Virginia

The obvious solution to prosecute the hospital for fraud followed by a civil suit”A hospital charged nearly $7,000 for a procedure that was never performed” https://t.co/wPNNZ5cZey

— Barry Ritholtz (@ritholtz) October 31, 2022

— Barry Ritholtz, New York City

Patients as Watchdogs

Thank you for the article on Lupron Depot injections (Bill of the Month: “$38,398 for a Single Shot of a Very Old Cancer Drug,” Oct. 26). Last year, I was diagnosed with prostate cancer, though my case is not anywhere as severe as that experienced by Mr. Hinds.

Last month my urologist scheduled an MRI update for me at a facility owned by Northside Hospital Atlanta. At the suggestion of my beloved wife, I called my insurance company, UnitedHealthcare, to make sure the procedure was covered. Fortunately, it was. That being said, the agent from UnitedHealthcare mentioned that Northside Hospital’s fee was “quite a bit higher than the average for your area.” It was. Before insurance, the charge for an MRI at Northside was $6,291. I canceled the appointment at Northside and had the MRI done by a free-standing facility. Their charge, before insurance, was $1,234.

Every single encounter that I have with the health care system involves constant vigilance against price-gouging. When I have a procedure, I have to make sure that the facility is in-network,. that each physician is in-network, that any attending specialist such as an anesthesiologist or radiologist is in-network (and their base-facility as well). If I have a blood test, I have to double-check if the cost is included in a procedure or if it is separate. If it is a separate fee, I have to ensure that the analysis is also covered, and, if it is not, that it is not done through a hospital-owned facility but instead through a free-standing operation.

I have several ongoing conditions in addition to my prostate cancer — Dupuytren’s contracture, a rare bleeding disorder similar to thrombocytopenia, and arthritis. Needless to say, navigating our byzantine, inefficient, and profit-driven health care system is a total nightmare.

Health care in the United States has become so exceedingly outrageous. I cannot understand why it is not an issue that surfaces during election years or something that Congress is willing to address.

Again, thank you for your excellent reporting.

— Karl D. Lehman, Atlanta

Why capitalism without guardrails is a pipedream. Own the patent, control the pricing, and this is the result: $38,398 for a Single Shot of a Very Old Cancer Drug https://t.co/BLes77QN7F via @Centre County Reportews

— Brian Murphy (@NorwoodCDI) October 26, 2022

— Brian Murphy, Austin, Texas

I was a medical stop-loss underwriter and marketer for over 30 years. Most larger (company plans for 100-plus employees) are self-funded, meaning the carrier — as in this case, UnitedHealthcare — is supplying the administrative functions and network access for a fee, while using the employer’s money to pay claims.

Every administrator out there charges a case management fee, either as a stand-alone charge or buried in their fees. Either way, they all tout how they are looking out for both the employer and the patient.

Even if this plan was fully insured, wouldn’t it have been in the best interest of all parties when they became aware of the patient’s treatment (maybe after the first payment) to reach out to the patient and let them know there are other alternatives?

The question in these cases is who is minding the store for both the patient and the employer. The employer, the insurer, and the patient could have all saved a lot of money and pain, if someone from case management had actually questioned the first set of charges.

— Fred Burkacki, Sarasota, Florida 

I did a few rounds of Lupron in my 20s for severe #endometriosis, and I had to fight my insurance company to get approved. Now, this is how much it costs for some people. https://t.co/UlB1TTtW40 #healthcare #prostatecancer

— Amanda Oglesby 🌊 (@OglesbyAPP) October 26, 2022

— Amanda Oglesby, Neptune, New Jersey

‘Bill of the Month’ Pays Off

I received a $1,075 refund on a colonoscopy bill I paid months earlier after listening to the Centre County Report-NPR “Bill of the Month” segment “Her First Colonoscopy Cost Her $0. Her Second Cost $2,185. Why?” (May 31) and finding out the procedure should be covered under routine health care coverage. Thank you!

— Cynthia McBride, University Place, Washington

We have to close legal loopholes to make sure that cancer diagnostic procedures have the same insurance coverage as screening. Colonoscopies must be fully covered whether a polyp is found or not #ACA #colorectalcancer #CancerScreening https://t.co/slE6p3FvHe

— Erica Warner, ScD (@ewarner_12) May 31, 2022

— Erica Warner, Boston

Removing Barriers to Benefits

In the story “People With Long Covid Face Barriers to Government Disability Benefits” (Nov. 9), you stated: “Many people with long covid don’t have the financial resources to hire a lawyer.” This is incorrect. When applying for disability, you don’t need financial resources. There are law firms that specialize in disability claims and will not charge you until you win your claim. And, according to federal law, those law firms can charge only a certain percentage of the back pay you would get once the claim has been won. Also, if you lose the claim, and the law firm has appealed as many times as possible, you don’t owe anything. Please don’t make it more difficult for those who are disabled with misinformation.

— Lorrie Crabtree, Los Angeles

People unable to work due to Long Covid are facing barriers to obtaining government disability benefits.https://t.co/zWQfW5CkOS

— Ron Chusid (@RonChusid) November 10, 2022

— Ron Chusid, Muskegon, Michigan

Vaccine Injuries Deserve Attention, Too

I read your long-covid article with interest because many of the barriers and some of the symptoms faced by people with long covid are similar to those experienced by people with vaccine injuries. I’m really concerned about how there is even less attention and support for people who suffered adverse vaccine reactions.

Long covid and vaccine injuries are both issues of justice, mercy, and human rights as much as they are a range of complex medical conditions.

It’s nearly 20 months since someone I know sustained a serious adverse reaction, and it is heartbreaking how hard it has been for her to find doctors who will acknowledge what happened and try to help. There’s no medical or financial support from our government, and the Countermeasures Injury Compensation Program is truly a dead end, even as other countries such as Thailand, Australia, and the United Kingdom have begun to acknowledge and financially support people who sustained vaccine injuries.

I’ve contacted my congressional representatives dozens of times asking for help and sharing research papers about vaccine injuries, but they have declined to respond in meaningful ways. Similarly, my state-level representatives ignore questions about our vaccine mandate, which remains in place for state employees, despite at least one confirmed vaccine-caused fatality in a young mother who fell under the state mandate in order to volunteer at school.

There have been a few articles, such as …

… but no new ones have come to my attention recently, and it is concerning that the media and our political and public health leaders seem OK with leaving people behind as collateral damage.

Please consider writing a companion piece to highlight this need and the lack of a functional safety net or merciful response. My hope is that if long covid and vaccine injuries were both studied vigorously, new understanding would lead to therapeutics and treatments to help these people.

— Kathy Zelenka, Port Angeles, Washington

Given how long it took Congress to eventually approve “Agent Orange” and “Burn Pit” benefits for disabled veterans, it is at least a 15-20 year time frame and they don’t have the backing or societal standing that veterans do. https://t.co/idt6tSioHc

— Matthew Guldin (@MRG_1977) November 11, 2022

— Matthew Guldin, West Chester, Pennsylvania

More on Mammograms

The article “Despite Katie Couric’s Advice, Doctors Say Ultrasound Breast Exams May Not Be Needed” (Oct. 28) does a disservice to women and can cause harm. An ultrasound is saving my life. I had two mammograms with ultrasounds this year. Although the first mammogram showed one cyst that was diagnosed as “maybe benign,” I knew it wasn’t. Why? Because I could feel the difference. I insisted on a second, and sure enough a large-enough cyst that’s definitely malignant was found. I had breast surgery on Oct. 31, followed by radiation treatment and, if needed, chemotherapy later. This article will deprive other, less aggressive and experienced women who do not have health care credentials or a radiologist for a husband to be harmed by being lulled into complacency.

— Digna Irizarry Cassens, Yucca Valley, California

Why do some women with dense breasts get additional screening while others do not? ⁦@CNN⁩ explains. ⁦@IronwoodCancerhttps://t.co/uFZZKo6RO4

— Patricia Clark (@patriciaclarkmd) October 27, 2022

— Patricia Clark, Scottsdale, Arizona

Your article on breast cancer screening neglected to present the supplemental option of Abbreviated Breast MRI (AB-MRI). The out-of-pocket cost at many clinics ranges from $250 to $500. For a national listing of clinics that offer this supplemental screening option, please go to https://timetobeseen.org/self-pay-ab-mri. For benefits, just Google “Abbreviated Breast MRI.”

— Elsie Spry, Wexford, Pennsylvania

Why didn’t more #SeniorCitizens leave for safer havens during Hurricane Ian as recommended? ⁦@judith_graham⁩ rightfully suggests that learning why is critical as the population of older people grows and #NaturalDisasters become more frequent. https://t.co/7k8bvNQxug

— Donald H. Polite (@DonaldPolite) November 2, 2022

— Donald H. Polite, Milwaukee

Preparation Plans for Seniors: All for One and One for All

At least 120 people died from Hurricane Ian, two-thirds of whom were 60 or older. This is a tragedy among our most vulnerable population that should have been prevented (“Hurricane Ian’s Deadly Impact on Florida Seniors Exposes Need for New Preparation Strategies,” Nov. 2).

Yes, coming together and developing preparedness plans is one way to protect seniors and avoid these kinds of tragedies in the future, but since this is not a one-size-fits-all situation, organizations that help seniors across the country must first look internally and be held accountable by making sure their teams always have a plan in place and are prepared to activate them at a moment’s notice.

During Hurricane Ian, I saw firsthand what can happen when teamwork and effective planning come together successfully to protect and prepare seniors with chronic health conditions like chronic obstructive pulmonary disease who require supplemental oxygen to breathe.

Home respiratory care providers and home oxygen suppliers worked tirelessly to ensure our patients received plenty of supplies to sustain them throughout the storm, and when some patients faced situations where their oxygen equipment wasn’t working properly inside their homes, staff members were readily available to calmly talk the patient through fixing the problem. After the winds receded, mobile vans were quickly stationed in safe spaces for patients or their family members to access the oxygen tanks and supplies they needed. If patients were unable to make it to these locations, staff members were dispatched to deliver tanks to their homes personally and check in on the patient.

Patients were also tracked down at shelters, and a team of volunteers was formed around the country to find patients who could not be reached by calling their emergency backup contacts, a friend, or family member. Through these established systems, we were able to remain in contact with all of our patients in Ian’s path to ensure their care was not impeded by the storm.

Organizations should always be ready and held accountable for the seniors they care for in times of disaster. I know my team will be ready. Will yours?

— Crispin Teufel, CEO of Lincare, Clearwater, Florida

Understanding the impact of #Climatechange on older people is critically important as the population expands and #naturaldisasters become more frequent and intense.https://t.co/RKB7pA28nr

— Ashley Moore, MS, BSN Health Policy (@MooreRNPolicy) November 2, 2022

— Ashley Moore, San Francisco

The Tall and the Short of BMI

I am amazed that in your article about BMI (“BMI: The Mismeasure of Weight and the Mistreatment of Obesity,” Oct. 12) you never mentioned anything about the loss of height. If a person goes from 5-foot-2 to 4-foot-10, the BMI changes significantly.

— Sue Robinson, Hanover, Pennsylvania

I’ve been against this since after gastric bypass surgery I got down to 164 pounds but at 5’7″ BMI still considered me overweight. How an overreliance on BMI can stand between patients and treatment https://t.co/OawzhO0aOk

— Steve Clark (@blindbites) October 10, 2022

— Steve Clark, Lee’s Summit, Missouri

Caring for Nurses’ Mental Health

During the pandemic, when I read stories about how brave and selfless health care heroes were fighting covid-19, I wondered who was taking care of them and how they were processing those events. They put their own lives on the line treating patients and serving their communities, but how were these experiences affecting them? I am a mother of a nurse who was on the front lines. I constantly worried about her as well as her mental and physical well-being (“Employers Are Concerned About Covering Workers’ Mental Health Needs, Survey Finds,” Oct. 27). I was determined to find a way to honor and support her and her colleagues around the country.

I created a large collaborative art project called “The Together While Apart Project” that included the artwork of 18 other artists from around the United States. It originated during the lockdown phase of the pandemic, a time when we were all physically separated yet joined by a collective mission to create one amazing art installation to honor front-line workers, especially nurses. Upon its completion, this collaboration was recognized by the Smithsonian Institute, Channel Kindness (a nonprofit co-founded by Lady Gaga) and NOAH (National Organization of Arts in Medicine). After traveling around the Southeast to various hospitals for the past year on temporary exhibit, the artwork now hangs permanently in the main lobby at the University of Virginia Medical Center in Charlottesville, Virginia.

I wanted to do something philanthropic with this art project to honor and thank health care heroes for their dedication over the past two years. It was important to find a way to help support them and to ensure they are not being forgotten. Using art project as my platform, I partnered with the American Nurses Association and created a fundraiser. This campaign raises money for the ANA’s Well-Being Initiative programs, which support nurses struggling from burnout and post-traumatic stress disorder and who desperately need mental and physical wellness care. Fighting covid has taken a major toll on too many nurses. Some feel dehumanized and are not receiving the time off or the mental and physical resources needed to sustain them. Many are suffering in silence and have to choose between caring for themselves or their patients. They should not have to make this choice. Nurses are the lifeline in our communities and the backbone of the health care industry. When they suffer, we all suffer. Whether they work in hospitals, doctors’ offices, assisted living facilities, clinics or schools, every nurse has been negatively impacted in some way by the pandemic. They are being asked to do so much more than their jobs require in addition to experiencing greater health risks, less pay, and longer hours. Nurses under 35 and those of color are struggling in larger numbers.

The American Nurses Foundation offers many forms of wellness care at no charge. They rely heavily on donations to maintain the quality of their offerings as well as the ability to provide services to a growing number of nurses. I am an artist, not a professional fundraiser, and I have never raised money before. But I feel so strongly about ensuring that nurses receive the support and care they deserve, that I am willing to do whatever it takes to advocate and elevate these health care heroes.

The Together While Apart Project’s “Thank You Nurses Campaign” goal is $20,200, an amount chosen to reflect the numbers 2020, the year nurses became daily heroes. So far, I have raised over $15,500 through gifts in all amounts. For example, a $20 donation provides a nurse with a free one-hour call with a mental health specialist. That $20 alone makes a big difference and can change the life of one nurse for the better. The campaign has provided enough funding (year to date) to enable 940 nurses to receive free one-hour wellness calls with mental health specialists.

The online fundraiser can be found at https://givetonursing.networkforgood.com/projects/159204-together-while-apart-fundraiser.

— Deane Bowers, Seabrook Island, South Carolina

CEAPs, is it time to offer more #mentalhealth services? Nearly 1/2 of employers (w/ 200 workers) report a growing share of workers using mental health services. Yet 56% report they lack #behavioralhealth providers for employees to access to timely care. https://t.co/Vpkkwlq6C6

— EAPA (@EAPA) October 27, 2022

— Employee Assistance Professionals Association, Arlington, Virginia

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WHO recommends new name for monkeypox disease

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November 28, 2022 Media Release Geneva, Switzerland

After a series of consultations with global experts, WHO will start using a new preferred term “mpox” as a synonym for monkeypox. Both names will be used simultaneously for one year while “monkey pox” is phased out.

As the monkeypox outbreak spread earlier this year, racist and stigmatizing language was observed online, in other settings and in some communities, and reported to the WHO. At several public and private meetings, a number of individuals and countries raised concerns and asked WHO to propose a way to change the name.

The designation of new and, very exceptionally, existing diseases is the responsibility of WHO, within the framework of the International Classification of Diseases (ICD) and the WHO family of international health-related classifications, through a consultative process involving WHO Member States.

WHO, in line with the ICD update process, held consultations to gather the views of a range of experts, as well as countries and the general public, who were invited to submit proposals for new names. Based on these consultations and further discussions with WHO Director-General Dr. Tedros Adhanom Ghebreyesus, the WHO recommends the following:

  • Introduction of the new English synonym mpox for the disease.
  • Mpox will become a preferred term replacing monkeypox after a one-year transition period. This is to allay concerns raised by experts about the confusion caused by a name change amid a global outbreak. There is also time to complete the ICD update process and update WHO publications.
  • The synonym mpox will be included online in the ICD-10 in the next few days. It will be part of the official release in 2023 of ICD-11, the current global standard for health data, clinical documentation and statistical aggregation.
  • The term “monkeypox” remains a searchable term in the ICD to match historical information.

Considerations for the recommendations included rationale, scientific adequacy, level of current use, pronounceability, usability in different languages, lack of geographic or zoological references, and ease of retrieval of historical scientific information.

Typically, the ICD update process can take up to several years. In this case, the process was expedited, although it followed the standard steps.

Various advisory bodies were heard during the consultation process, including experts from the Medical and Scientific Advisory Committees, as well as the Classification and Statistical Advisory Committees, composed of representatives from government agencies from 45 different countries.

The question of using the new name in different languages ​​was discussed at length. The preferred term mpox can be used in other languages. If additional naming issues arise, they are addressed through the same mechanism. Translations are usually discussed in formal collaboration with the relevant government agencies and associated scholarly societies.

WHO will adopt the term mpox in its communications and encourages others to follow these recommendations to minimize any ongoing adverse impacts of the current name and adoption of the new name.

Name disease:

  • Human monkeypox got its name in 1970 (after the virus that causes the disease was discovered in captive monkeys in 1958), before the publication of WHO best practices in naming diseasespublished in 2015. According to these best practices, new disease names should be assigned with the aim of minimizing unnecessary negative impacts of names on trade, travel, tourism or animal welfare and avoiding causing cultural, social, national or regional offending, professional – or ethnic groups.
  • Renaming new and, very exceptionally, existing diseases is the responsibility of WHO International classification of diseases and the WHO Family of International Health-Related Classifications (WHO-FIC) through a consultative process involving WHO Member States. ICD is part of the WHO family of international health-related classifications (WHO-FIC).

Naming Viruses:
The naming of viruses is the responsibility of the International Committee on the Taxonomy of Viruses (ICTV). Prior to the global monkeypox outbreak of 2022, a process was already underway to reconsider the naming of all orthopoxvirus species, including monkeypox virus. This will continue under the leadership of ICTV.

Naming of monkeypox virus variants or clades:
In August, a group of global experts convened by the WHO agreed on new names for monkeypox virus variants as part of an ongoing effort to align the names of the monkeypox disease, the virus and the variants – or clades – with current best practices. Agreement was reached to designate the former Congo Basin (Central Africa) clade as clade one (I) and the former West African clade as clade two (II). In addition, it was agreed that Clade II consisted of two subclades, IIa and IIb. See WHO press release on naming of monkeypox clades.


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Work comp rates drop, behavioral health in WC, and workers as assets not costs

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Happy Monday – to my American readers, I hope your vacation was excellent.

Here’s good stuff you might have missed…

WCRI organizes a free webinar about behavioral health in Workers’ Compensation Thursday, December 15 at 2 p.m. Eastern Time. The webinar will discuss their recent introduction to BH in WC (available here for download)

The good folks at NCCI released her Latest view of labor compensation industry finances...suffice it to say the party goes on…although it may be nearing the end.

Courtesy of NCCI

The final nationwide analysis of the 2021 results shows:

      • Net written premium (NWP) for private airlines in WC calendar year 2021 increased 0.5% from 2020 to US$38.2 billion
      • The combined ratio for private airlines in the 2021 WC calendar year was 87.2% and operating profit was 23.7%.

Meanwhile, early dates make 2022 look even better; Direct premiums written increased nearly 10% from 2021, while the Claims ratio for the first two quarters of 2022 even lower (!!!) than 2021 (no figures).

unpacking –

  • If the numbers hold up for 2022, 2022 will be the tenth consecutive year that earnings have exceeded historical averages…
  • And for the sixth straight year, operating margin exceeded 20%
  • Oh, and that’s all happened while prices have fallen every year since 2014

My Opinion… Insurers are still hugely profitable because rate declines don’t exactly reflect that opioid hangover.

[A CWCI report addressed this issue; my informed opinion is claims without opioids are much less costly, therefore the continued drop in opioid prescriptions is driving lower claims costs…actuaries develop rates based on historical data – which is not keeping up with what’s actually happening.]

Former Secretary of Labor Robert Reich believes Organizations misvalue workers…Reich notes that workers are viewed as “expenses” rather than assets, a mischaracterization that leads to all sorts of bad management decisions.

key line –

“Companies are increasingly not just production systems. They are systems for steering the expertise, to know, what, know whereand know why of the people who work in it.”

Hat tip to a very good friend for the head is up.

What does that mean for you?

  1. It’s great to see behavioral health getting more attention — it’s an important factor in recovery.
  2. Actuaries use historical data to forecast the future; Leaders should consider what is really happening to understand where things are going.
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